Funding Models to Support Quality and Sustainability: A Pan-Canadian Dialogue
Summary Report
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Cette publication est aussi disponible en français sous le titre Modèles de
financement pour favoriser la qualité et la durabilité : un dialogue pancanadien —
rapport sommaire.
Table of Contents
Summary ................................................................................................................. iii
Introduction ............................................................................................................. 1
Presentations, Themes and Reflections ................................................................. 2
Dialogue Design ..................................................................................................... 3
Key Learnings ......................................................................................................... 4
Activity-Based Funding as a Driver of Change .............................................. 4
The International Experience .................................................................... 6
Designing Activity-Based Funding Models ................................................... 7
Case-Mix Systems ................................................................................... 7
Cost-Weighting Systems ......................................................................... 8
Cost and Budget Implications ..................................................................... 9
The Canadian Landscape ........................................................................... 9
Implementation Perspectives of Physicians, Management
and the Front Line .................................................................................... 10
Challenges for Canadian Health Systems: The Way Forward ............................ 11
Activity-Based Funding: 11-Point Checklist for Change ...................................... 13
Appendix A—Faculty ............................................................................................ 15
Appendix B—Program Advisory Committee ........................................................ 17
Appendix C—Health System Funding Forum Survey ......................................... 19
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Funding Models to Support Quality and Sustainability: A Pan-Canadian Dialogue
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Summary
This report highlights key points raised in plenary presentations and discussion
periods at the invitational forum Funding Models to Support Quality and
Sustainability: A Pan-Canadian Dialogue. The plenary presentations and
audio recordings from the keynote presentations are available on the partner
organizations’ websites, as is background material. Summary points arising from
the discussion periods are contained in this document.
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Introduction
On November 25 and 26, 2010, in Edmonton, Alberta, the national forum
Funding Models to Support Quality and Sustainability: A Pan-Canadian
Dialogue took place. Hosted by the Canadian Institute for Health Information
(CIHI), in collaboration with the Institute of Health Economics (IHE) and the
Canadian Health Services Research Foundation (CHSRF), this forum provided
a unique opportunity for senior leaders to hear from national and international
experts about funding models to support quality and sustainability, with a
particular emphasis on activity-based funding approaches for hospital services.
The forum presentations and audio and video content can be found online at
http://www.cihiconferences.ca/HSFF2010/?doc=welcome and
www.ihe.ca/research/funding-models-conference/.
Background summary papers can be found online at
www.ihe.ca/research/funding-models-conference/background-papers-1/.
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Presentations, Themes and Reflections
Canadian jurisdictions continue to seek solutions to address wait times and
access to health care services. Many are assessing if these concerns can be
at least partly addressed by changing how funding is allocated.
A Primer on Activity-Based Funding (CIHI discussion paper), October 2010
Reform, re-engineering, redesign, renewal . . . What impact can activity-based
funding have on driving the pan-Canadian objectives of using health care
resources more effectively, providing high-quality care and integrating services?
Can it assist in putting patients first? Will it help reduce wait lists?
Canada is one of the few developed countries in the world that has not adopted
activity-based funding as a primary funding methodology. The national legacy of
global funding for hospitals makes it difficult to compare or understand costs
across institutions, resulting in a limited ability to identify more or less productive
approaches to providing the same care. In turn, this makes cutting services the
easiest way to control costs—at the expense of patient access. And while not a
panacea, activity-based funding may be one lever capable of supporting more
efficient care in some areas of the health care system. If so, what lessons can be
learned from the experiences of Canadian and international jurisdictions?
In November 2010, health leaders from across Canada gathered in Edmonton,
Alberta, for two days to discuss and examine activity-based funding models,
both the theory and the practical considerations of their implementation within
hospitals and other settings. At the outset, participants were asked to look
beyond process change and examine funding as one way to assist in re-
engineering the system.
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Dialogue Design
The dialogue began with addresses from the sponsors of the session:
John Wright, President and CEO, CIHI; Jay Ramotar, Deputy Minister,
Alberta Health and Wellness, and Board Member, IHE; and Stephen Samis,
Vice President, Policy, CHSRF.
Reinhard Busse, of the Berlin University of Technology and WHO European
Observatory on Health Systems and Policy, provided an in-depth review of the
fundamental building blocks and use of diagnosis-related groups (DRGs) in
Europe, and he laid out the pros and cons of various DRG models and
outcomes arising from the use of different models.
The discussion then moved to the experiences of and lessons learned in other
jurisdictions, including the perspectives of Martin Campbell (England), Deputy
Director, Payment by Results Development, Department of Health, National
Health Services; Peter McNair (Australia), Associate Director and Clinical
Epidemiologist, Palo Alto Medical Foundation Research Institute, and Visiting
Fellow; and Murray Ross (United States), Vice President, Kaiser Foundation
Health Plan Inc., Kaiser Permanente Institute for Health Policy.
Day two opened with thoughts on the Canadian experience and perspectives
on the challenges facing Canadian health systems from Chris Mazurkewich,
Executive Vice President and Chief Financial Officer, Alberta Health Services;
Saäd Rafi, Deputy Minister, Ontario Ministry of Health and Long-Term Care; and
Les Vertesi, Executive Director, B.C. Health Services Purchasing Organization.
The final cluster of speakers discussed issues of implementation from the
perspective of providers and administrators. Christopher Doig, professor
and Head, Community Health Services, University of Calgary; Kevin Empey,
President and Chief Executive Officer, Lakeridge Health Corporation; and
Lynn Stevenson, Executive Vice President, People, Organizational Development
Practice, and Chief Nurse, Vancouver Island Health Authority, shared their
perspectives and what they have learned.
The sessions closed with a presentation by Jason Sutherland, assistant
professor, School of Population and Public Health, University of British
Columbia, and faculty, UBC Centre for Health Services and Policy Research,
who synthesized the input provided by attendees to a participant survey (see
Appendix C) that was completed during the first day of the forum. He also
provided a summative perspective on key take-away messages.
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Throughout the two days, a number of health leaders offered their reflections on
the presentations. These leaders included Jason Sutherland; Leslee Thompson,
President and CEO, Kingston General Hospital; Les Vertesi; and Tom
Noseworthy, professor, University of Calgary. Speakers also participated as
reflective panel members during the sessions.
Key Learnings
Activity-Based Funding as a Driver of Change
Provider payment is central to the performance of any health system. Within
a hospital setting, incentives created by different forms of payment can help
achieve desired outcomes in terms of quality, simplicity of administration,
productivity and adherence to evidence-based medicine. However, funding
models are not an end in themselves—they are one of a handful of levers to
help achieve objectives.
Presenters were clear—prior to designing a funding system, it is critical to
understand the issues that must be addressed and to establish clear strategic
goals and objectives for the health system. These goals and objectives will
guide the decisions that must be made when designing an activity-based
funding model.
No one model is perfect. Global budgets are simple and inexpensive to
administer but can lead to under-treatment and longer wait times. Per diem
payment systems can result in people being over-treated and may not be an
incentive to quality. Fee-for-service payments encourage the delivery of more
services but are expensive. Figure 1 illustrates the incentives linked to the
different forms of hospital payment.
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Figure 1: Incentives Linked to Different Forms of Hospital Payment
Source
Reinhard Busse, “The ABCs of DRGs: The European Experience,” presented at Funding Models to Support
Quality and Sustainability: A Pan-Canadian Dialogue in Edmonton, Alberta, on November 25, 2010.
Activity-based funding (ABF) models bring their own issues. While they can
encourage providers to treat more people, they may also result in a reduction in
the number of services a person receives if the model used isn’t sufficiently
sensitive to issues of severity. Several presenters cautioned that if there is a
loophole, providers will find it, and that funders will not gain much if they control
price and providers control volume.
Overall, ABF tries to balance incentives to promote productivity and decrease
costs. ABF can
Provide a common measure of hospital activity and bring transparency to the
costs and activities within an institution and among institutions and jurisdictions;
Create the basis for stronger performance measures and efficiency benchmarking;
Allow for the better allocation of costs among different payers;
Help address capacity issues;
Make the process of budget allocation technical, not political; and
Eliminate the incentive to reduce costs by reducing activity.
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The International Experience
The Australia experience indicates that ABF is useful in driving efficiency, is
neutral to slightly positive in containing costs per episode of care and can
increase timeliness and reduce wait lists. The evidence is less clear on whether
it results in a more equitable distribution of resources, encourages the use of
clinical pathways, reduces variation or addresses patient safety issues.
In England, payment by results was introduced in the 1990s to give patients choice
about which hospital would provide their care (that is, money follows the patient)
as well as to increase efficiency and reduce wait times. Modifications to the initial
model were subsequently made to discourage negative consequences, such as
the under-treatment of difficult cases and discharges from one hospital to another
when stays began to exceed the average. The results now show a reduction in the
unit costs of care, an increase in the volume of care and no negative impact on the
quality of care.
In the U.S., Medicare began using ABF in the early 1980s to preserve access to
care while giving providers an incentive to deliver care more efficiently. The results
are mixed and provide insight into the importance of design choices and rigorous
monitoring to watch for unintended consequences. For example, there is evidence
that coding became weighted toward greater acuity and higher payments.
Overhead was reallocated to sub-acute settings, increasing payments to
hospitals with sub-acute settings. One clear benefit was a decrease in the
length of patient stays.
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Designing Activity-Based Funding Models
Finding the balance between formula simplicity and formula precision is at the
heart of the issue when designing an ABF model. The more complex a model is
the more sensitive it may be to local conditions and patient mix. However, a
sophisticated and costly system that is understood by only a few may be less
effective in ensuring fairness and reducing costs than a simpler and more easily
understood solution.
Model design choices will also be shaped by the current culture—the existing
administrative and funding arrangements and the ways administrators and
providers have come to relate to these funding incentives. When ABF was
introduced in the U.S. by Medicare, lengths of stay and activities decreased. In
Europe, lengths of stay decreased while activities increased. This can be at least
partly attributed to the histories of each jurisdiction: the U.S. transitioned from a
fee-for-service model, while in Europe the legacy systems were either global
budgets or a system of per diem payments.
Case-Mix Systems
ABF models use groupings of patient episodes—derived from a case-mix
system—as their fundamental building blocks. These groupings should be
medically meaningful and encompass financially homogeneous patients whose
treatments have similar costs.
Common to all case-mix systems are certain high-level business rules that
determine to which grouping each patient episode belongs. All case-mix
systems consider the patient status at admission. They also consider variables
that arise during the patient’s episode of care: medical and management
variables, the mix of procedures, technologies and human resource
requirements. It is important that these systems look beyond diagnoses when
considering resource consumption. What the hospital should do in treating
patients needs to be considered; otherwise, there can be very strong incentives
to under-treat patients.
Case-mix systems by their nature are designed for specific clinical settings (for
example, long-term care versus inpatient) and are reliant upon the classification
systems that describe the clinical details of each unique episode. The number of
distinct groupings produced by a case-mix system depends on the level of
granularity that is needed for analytical and management purposes. More
groupings allow for higher levels of refinement and can produce more accurate
payments. The by-product, however, is complexity. In Canada, CMG+
recognizes 600 groupings, while Germany’s DRG system recognizes 1,200
and the Netherlands’ system has 3,000.
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International experience indicates that 90% of all patients fall into 30% of the
groupings. The remaining 10% of patients tend to have more complex
conditions requiring treatment in tertiary or quaternary hospital settings at
variable and often high costs. The variation between cases with similar but not
identical needs must be captured by a case-mix system to ensure the system is
fair and is seen to be fair.
Finally, it is critical to determine which services should be included in an ABF
system. Many jurisdictions have determined that mental health, chemotherapy
and radiation are services, for example, that are often dealt with outside the
mainstream model because of the extended period of treatment time and
consequent costs associated with these services.
Cost-Weighting Systems
Having agreed upon a case-mix grouping methodology for use in a funding
allocation system, the next and critical step in designing an ABF model is to
estimate the cost per patient episode. Case-mix methodologies typically attach
a relative cost weight to each case-mix group. The appropriate cost weight is
assigned to each patient episode based upon the group in which the episode
falls. The estimated cost for a patient episode is then the cost weight assigned to
the episode multiplied by a base rate. The base rate is a dollar amount per unit
of cost weight. The resulting dollar value forms the basis for the price to be paid
for the episode.
When implementing an ABF model, it is important to ensure the hospital
volumes, rates and weights are calculated to add up to the available funding; it
is on this basis that the base rate is established. To tailor a funding system and
improve fairness, the base rate can be further modified to take into account
variations within the system. This may be desirable when costs are higher in
different hospitals for structural or other reasons or when there are geographic
disparities. For example, hospitals in London are paid using a higher base rate
than hospitals elsewhere in England to reflect geographic and cost realities.
Australian hospitals in remote areas have a higher base rate. In Canada,
consideration may need to be given to addressing issues around remote and
rural community care or other regional adjustments.
There also are ways to address differences through non-ABF funding
mechanisms, such as block funding for teaching and research functions to
reduce cost disparities for academic hospitals. In Australia, ABF is used for
about 70% to 75% of hospital payments. Grants are used to fund services such
as community service obligations, capital, teaching and research outside of
ABF. Mental health cases are paid for on a per diem basis.
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Cost and Budget Implications
ABF does not necessarily reduce costs, but it can help manage them. Cost and
budget projections based on case-mix groups tend to be much more precise
than those based on a global budget approach and can clearly demonstrate
what is being produced. In Europe, cost weights are negotiated with purchasers
and establish the price of purchasing services. A hospital might be contracted to
produce one million cost weights at a certain rate, and if it goes above that level
it is reimbursed at a discounted cost value.
Understanding the starting point for costing requires good-quality data that
should be gathered locally to ensure accuracy and confidence in those affected
by funding decisions. Administrators, in conjunction with stakeholders, need to
determine what costs will be recognized. In Germany, costs are established on
the basis of average costs in 300 representative hospitals. In England, the
system is moving toward paying on the basis of best practice costs.
Then there are system costs for maintaining an ABF model. Monitoring may not
be that expensive and is only cents per case for the DRG Institute in Germany.
The health care system has a high volume of cases, which is important to keep
in mind. Costs are higher in hospitals because of the need for rigour around
coding. The impact of documentation requirements needs to be considered,
particularly because physicians participate in coding both diagnoses and
treatments, and this coding affects to some extent the remuneration provided to
them either directly (via fee for service) or indirectly (via their salary). Different
jurisdictions have different approaches to physician funding. In France,
physicians in private hospitals are salaried. The Netherlands sets out an amount
in the ABF envelope for physician payments. In Germany, doctors in hospitals
tend to be salaried.
The Canadian Landscape
With Canada’s “system of systems” health care landscape, the choice of a
funding model will be influenced by the structure, culture and funding available
in a particular jurisdiction. As provinces look to manage costs, provide incentives
for quality and work to integrate care from the community to hospitals and
continuing care, the question arises as to how funding models can support care
by ensuring that services are provided by the right provider in the right place at
the right time. Can ABF assist in achieving this overall goal, or does it
necessarily support the role of hospitals over care delivered in the community
and elsewhere?
The forum heard that Alberta’s single region is looking at how to achieve the
provincial goal of the best-performing publicly funded health system in Canada.
Using population-based funding as a starting point, decisions will be made
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around how to further allocate resources to best provide services and ensure
quality and access. This involves looking at the different funding models
currently being used across the province, determining which of these are most
effective and then moving to consolidate uniform approaches to funding. This
activity will require a strong project framework and dedicated support from
operations, strategy and finance to ensure successful implementation.
In Ontario, hospitals are independent entities, and three independent funding
methodologies are used: global funding, volume funding and funding for
efficiency. The province is working to curb spending and improve quality and
access by using evidence to drive changes, the Excellent Care for All Act and a
new mandate for the Ontario Health Quality Council. Patient-based funding is
being looked at as a further way to induce change and improve access.
British Columbia has established the B.C. Health Services Purchasing
Organization, which is seeking to improve access, quality and efficiency by
providing regional health authorities with specific funding for projects designed
to increase the number of hip and knee procedures, reduce emergency
department congestion and improve selected other services. This organization
is now responsible for purchasing approximately 20% of services provided by
hospitals within the province. Because the organization is specifically funding
certain procedures using an ABF approach, the incentive to cut services to
meet financial costs has been removed. Wait lists are being reduced and
money is being put into quality by hospitals, because cost savings from
efficiency and quality improvements stay within the system and can be used
for regional priorities.
Discussion at the forum suggested provinces can learn from each other and
ensure that we move from being a nation of pilot projects to creating pan-
Canadian approaches where they make sense. For example, B.C. is working
with other jurisdictions to structure a pan-Canadian approach to purchasing
equipment. Ontario is looking at a similar strategy with respect to drug
purchasing. Through these and other initiatives, jurisdictions can avoid
duplication of effort and address similar issues efficiently.
Implementation Perspectives of Physicians, Management
and the Front Line
Funding models are only one aspect of a complex interplay of management,
clinician involvement, incentives and budgeting needed to achieve goals.
Moving from a global budget to ABF is a major shift by any account and affects
everyone in the system, including management, support staff, physicians and
other health care providers. How that happens is an important design and
implementation consideration.
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For physicians, while the effects can include improved access for their patients,
ABF can also affect how they’re remunerated for their services and the
administrative work required of them to code diagnoses and treatments.
For management, ABF can change the levers for effecting efficiencies, securing
funding and motivating physicians and staff in hospitals. Management will need
to look for ways to keep up volumes and maintain their budgets. Ensuring
accurate and timely data on the type and volume of services provided is critical.
Without it, the organization risks funding reductions that may be difficult to
absorb. Management may need to develop stronger capacity in impact
assessment, predictive modelling and the ability to create buy-in among staff
and physicians.
The forum also heard that is it vital to engage staff appropriately around changes
in funding methodologies. Staff know how to deliver services and are the ones
who will actually make the efficiency gains. Staff will be more interested in
changes if they are presented as being tied to strategic goals and to things that
matter to patients. For this reason, managers must be able to tell the stories
about what changes will mean to things that staff care about, not what
management cares about. To do so, managers need to learn to talk in plain
speak, not management code. It is also important to understand that doing more
and being more efficient means that staff will be running faster. Therefore, as
volumes increase, workloads increase and it becomes important to look along
the continuum of activities in the hospital to address issues.
Challenges for Canadian Health
Systems: The Way Forward
If there is a shared understanding that ABF is not a panacea for all that ails the
health system, it is accompanied by an appreciation that global funding is a
reasonable instrument that can help address the quality, access and efficiency
issues in the system. Part of the way forward can lie within ABF, particularly if it
can be strategically designed in ways that support an integrated patient-centred
system. The bottom line, however, is the changes must result in better health
care, not more elegant accounting for resources.
Canada’s system of systems can be strengthened by using diversity to try
different approaches to improvement. For example, different jurisdictions
might try to improve integration of care between the community and institutions
by withholding hospital payments when certain hospital admissions are
preventable through better community care. Others could look at taking the
episode of care to the patient level (such as funding a diagnosis of congestive
heart failure at the patient condition level regardless of the setting) and providing
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incentives to the system to keep the patient stable in the community. Results
could then be shared among jurisdictions, thus helping to strengthen health
care in all jurisdictions.
A further question for each jurisdiction is whether it is necessary for each province
to build its own approach to ABF. Countries with much larger populations than
Canada’s have one system, and modifications that recognize specific jurisdictional
realities are possible. Can CIHI’s CMG+ provide a common base, even if there
were regional adjustments in its application? The benefits could be more
transparency and the opportunity to share best practices on quality, innovation
and cost management.
Negotiations around a new national health accord could provide an opportunity
to discuss funding models and their relation to the jurisdictions’ search for
improved quality and productivity. Further research into best practices around
benchmarking, evaluation, administrative practices and consistent measurement
would also support quality and productivity improvements. The energy and
engagement of forum participants suggests a level of interest in approaches to
funding methodologies that will be important to address over the next few years.
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Activity-Based Funding: 11-Point
Checklist for Change
1. Establish a clear vision of the health care system of the future, then establish
goals and design a funding system to support this vision. Create a funding
model around where the system should be going, not where it is now, and
remember that funding models are only one aspect of a complex interplay
of research, management, clinician involvement, incentives and budgeting
needed to achieve goals.
2. Good funding systems take time to build; transparency and commitment
are critical for ensuring the success of an ABF model. Funders have to
demonstrate consistency and long-term commitment or systems and
hospitals won’t change their behaviour.
3. Communicating the goals and potential impacts of new funding models to
clinicians and front-line staff is vital. Good communication will help ensure
that implementation addresses potential areas of concern, including the
possibility of increased workload, possible service impacts and any
anticipated resource shifting.
4. Manage the transition from global budgets to ABF, and introduce changes
incrementally and over time. Help ensure the long-term success of the
change by putting money in the system during implementation; don’t
jeopardize success by short-term cost containment.
5. Begin developing the model by creating the diagnostic groupings and
establishing a base unit from which to cost. Start with these weightings to
establish productivity measurement between hospitals and then adjust the
payments and establish budgets based on the weightings. This needs to be
done incrementally to manage cash flow.
6. Acknowledge that there are services and programs provided by hospitals
that should be addressed outside an ABF model.
7. Models should address how to fund those patients who do not fit within their
designated grouping. Without making such concessions, the system is at
risk of being seen as unfair and may lead to work-arounds to manage
higher-cost patients.
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8. It may be better to deal with specific high-cost services, such as
chemotherapy and radiotherapy, separately from the payments based solely
on the patient’s case-mix group assignment. The U.K., for example, has
chosen to unbundle such services, while supplementary payments are used
to address the issue in Germany.
9. Consider how to deal with innovation when developing the model. Because
innovation (such as new technology) can result in higher immediate costs,
an activity-based approach could identify a technologically advanced
facility as a higher-cost facility. To ensure the system accommodates
needed and useful innovation, this issue should be addressed overtly in
the planning stage.
10. Build in adjustments to provide incentives for quality. For example, in
England and Germany, there is no additional payment for readmitting a
patient for the same condition.
11. Expect that there will be unintended consequences arising from any ABF
model, no matter how thoughtfully designed, and that gaming will occur.
Constant monitoring, adjustments and updating are required.
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Appendix A—Faculty
Speakers (in Order of Presentation)
Reinhard Busse, Berlin University of Technology and WHO European
Observatory on Health Systems and Policy
Martin Campbell (England), Deputy Director, Payment by Results
Development, Department of Health, National Health System
Peter McNair (Australia), Associate Director and Clinical Epidemiologist, Palo
Alto Medical Foundation Research Institute, and Visiting Fellow
Murray Ross (United States), Vice President, Kaiser Foundation Health Plan
Inc., Kaiser Permanente Institute for Health Policy
Chris Mazurkewich, Executive Vice President and Chief Financial Officer,
Alberta Health Services
Saäd Rafi, Deputy Minister, Ontario Ministry of Health and Long-Term Care
Les Vertesi, Executive Director, B.C. Health Services Purchasing
Organization
Christopher Doig, professor and Head, Community Health Services,
University of Calgary
Kevin Empey, President and Chief Executive Officer, Lakeridge
Health Corporation
Lynn Stevenson, Executive Vice President, People, Organizational
Development Practice, and Chief Nurse, Vancouver Island Health Authority
Jason Sutherland, assistant professor, School of Population and Public
Health, University of British Columbia, and faculty, UBC Centre for Health
Services and Policy Research
Reflective Panel Members
(Speakers also acted as reflective panel members during the sessions)
Les Vertesi, Executive Director, B.C. Health Services Purchasing
Organization
Jason Sutherland, assistant professor, School of Population and Public
Health, University of British Columbia, and faculty, UBC Centre for Health
Services and Policy Research
Leslee Thompson, President and CEO, Kingston General Hospital
Tom Noseworthy, professor, University of Calgary (summative remarks)
The organizers would also like to thank Tom Noseworthy, professor, University
of Calgary, and Ron Sapsford, Chief, Strategy, Ontario Medical Association, for
moderating sessions.
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Appendix B—Program Advisory
Committee
The program and line-up of speakers for this forum were developed in
collaboration with a program advisory committee. We would like to thank the
following members for their valuable contribution to this forum.
Sten Ardal, Director, Health Data Branch, Health System Information
Management and Investment Division, Ontario Ministry of Health and
Long-Term Care
Martha Burd, Director, Modeling and Analysis Branch, Health System
Planning Division, Ministry of Health Services, British Columbia
Jeff Hatcher, Senior Consultant, CIHI
Christina Hoy, Director, Health Data Branch, Ontario Ministry of Health
and Long-Term Care
Chris Mazurkewich, Executive Vice President and CFO, Alberta
Health Services
Anne McFarlane, Vice President, Western Canada and Development
Initiatives, CIHI
Patricia McKendrick, Forum Planner, CIHI
Bernie Paillé, Special Project Lead, Western Canada, CIHI
Jitendra Prasad, Senior Vice President, Contracting, Procurement and
Supply Management, Alberta Health Services
Ian Rongve, Executive Director, Modeling and Analysis Branch, Health
System Planning Division, Ministry of Health Services, British Columbia
Stephen Samis, Vice President, Policy, Canadian Health Services
Research Foundation
John Sproule, Senior Policy Director, Institute of Health Economics
Howard Waldner, President and CEO, Vancouver Island Health Authority
Douglas Yeo, Director, Clinical Data Standards, Quality and
Methodology, CIHI
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Appendix C—Health System Funding
Forum Survey
Please take a few minutes to complete this survey. The results will be
summarized and shared with all participants as part of the health system funding
forum proceedings.
Jurisdiction
Organization (e.g. RHA, government, national organization, hospital)
1) What motivated you to attend the HSFF? (Please check the primary reason.)
Networking opportunities
Knowledge exchange
To learn more about activity-based funding
To hear from the experts
Fabulous Alberta weather
2) Are new funding models for institutional care being implemented (or
planned) in your jurisdiction?
Yes
No
If yes, what are the key drivers for introduction of the change?
(Choose as many as apply, using a scale of importance: 1—not very
important to 5—extremely important.)
a. To incent specific quality outcomes _____
b. To improve timeliness of access _____
c. To improve geographic access _____
d. To improve equity of access _____
e. To foster transparency in hospital funding ______
f. To increase value for money for hospital funding ______
g. Other (_______________________________) ______
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3) When introducing changes in hospital funding policies in your jurisdiction, what
are the barriers/inhibitors to implementation? (Check all that apply.)
High-quality accessible data
Expertise to guide implementation
Policy and communications
Stakeholder resistance or support
Other _______________________
4) The capacity/expertise to support implementation of funding policies is not
always readily available. What is your organization doing to build capacity to
support hospital funding model design, implementation, evaluation, etc.?
5) Where do you seek information regarding the potential effects of proposed
hospital funding policies?
6) Do you see a need for a national network of researchers and evaluators to
share knowledge and expertise on aspects of funding models? What
expertise would make this network valuable to you?
7) In follow-up to the forum, would you like to receive more information to assist
you in your work? If yes, what type of information would be helpful?
8) Please circle your overall assessment of this health system funding forum:
1 (not very useful) to 5 (very useful).
Overall assessment: 1 2 3 4 5
9) Additional comments